The World Health Organisation says breast milk from a healthy wet nurse is one of the best alternatives to direct breastfeeding.

About eight percent of SA babies are said to be exclusively breast-fed for the first six months of life, with 31 percent fed a diet of both breast milk and solid foods thereafter. According to Unicef we have among the world’s lowest breast-feeding levels.

SA’s under-five child mortality rate has shown little improvement since 1990.

Similarly, the breast-feeding rate has been stagnant since 2000, highlighting the need for initiatives that promote, protect and support exclusive and prolonged breast-feeding with the intention of reducing child mortality.

Few would argue with the notion that breast is best, but draft regulations on the topic, as they are written, place a restriction on information to health-care professionals that many are opposed to.

Lisa Walker, of The Infant Feeding Association (IFA), says it supports the government’s initiative but the regulations in their current form will limit the amount of information mothers are able to access about infant nutrition and complementary foods.

She says another (perhaps unintended but serious) consequence is that it may in fact increase levels of malnutrition and, potentially, child morbidity and mortality.


“Numerous studies irrevocably prove that breast-feeding is the single most effective nutrition intervention for saving lives,” Walker says.

She says the fact that breast-feeding needs to be encouraged is not what the association is contesting.

The regulations place a restriction on the dissemination of information.

Ann Richardson, professional clinic sister and author of baby books Baby Sense, Toddler Sense and Sleep Sense, explains.

“As it stands, infant formulas may not be marketed to consumers, so you’re not likely to see adverts on TV for formula.

“The draft is suggesting that health-care practitioners not be marketed to either. Cutting them off from information cuts parents off from information.”

Lize Mills, a senior lecturer in the Department of Private Law at Stellenbosch University, says the regulations are indeed restrictive and are an infringement on the fundamental right to freedom of speech.

She points to the recent decision of the Supreme Court of Appeal in British American Tobacco v Minister of Health (the judgment was handed down on June 20).

“The court emphasised that the protection of free speech, including commercial speech in the form of marketing and promotion of products, is guaranteed by section 16 of the constitution.

“Advertising allows the manufacturer, importer and other trader to impart information concerning its product. It also enables the consumer to receive such information and make consequent informed choices.

“As it was said, ‘the need for such expression derives from the very nature of our economic system, which is based on the existence of a free market.”

Mills says breast-feeding could be promoted in numerous ways, rather than prohibiting the promotion or advertising of infant formula completely – by prohibiting manufacturers from comparing their products to breast milk, for example, or by compelling manufacturers to clearly state that breast milk is the best option.

She expressed surprise that the succinct World Health Organisation (WHO) regulations were not adopted in this case.


Walker says apart from being unconstitutional on paper, the regulations don’t take into consideration the daily lives of many mothers.

“Many mothers often have to leave their babies in the care of a relative or caregiver far away from their primary residence due to few alternative options.”

Richardson agrees, saying: “We need to take a broader perspective on what it means to be a mom in South Africa before we judge. Some women are up at 4am waiting at a taxi rank to get to work, and they are home by 8pm. How are they supposed to breast-feed babies?”

Barbara le Grange, who is a clinic sister at Life Westville Hospital, says: “There will be moms who simply choose not to breast-feed. However, there are those who really want to but cannot.

“Many moms have to return to work after just four months of maternity leave while others have health complications and are unable to breast-feed.”

Cutting off moms from information is not going to help them.

“Governments need to be making life easier for mothers to encourage them to breast-feed,” says Walker.

“On a governmental level, a change in policy could be explored that grants mothers extended maternity leave. Corporate SA could place a stronger focus on creating child-friendly working environments that support mothers by allowing regular breast-feeding breaks and offering suitable places for mums to breast-feed their babies while working.”


Lynn Moeng, at the National Nutritional Directorate at the Department of Health, said the regulations had been grossly misunderstood. “This is a debate about brands,” she says.

“The main aim of adverts is to create awareness and encourage use of a product.

“Information will be provided to mothers who choose not to, or for any reason can’t, breast-feed. These mothers will be helped to make an informed choice.

“The regulations prevent practitioners from promoting specific brands to patients. They do not prevent them from offering information.

“The role of the health-care worker is to counsel mothers. It is not to promote products. If soy milk is needed, they can say so, we’re just preventing them from suggesting brands.”

She says health workers can receive scientific information about products, but this is different from marketing.

Mills disagrees, and interprets the regulations to be prohibiting the distribution of any information by a healthcare worker regarding infant formula.

“My concerns regarding these regulations (mainly regulation 7) is that in a practical situation it does not help a distressed mother. For example, a young teenage mother walks into a clinic; she is unable to breast-feed (due to health reasons, whether it is because she is HIV-positive or for other reasons).

“The sister at the clinic would not be allowed to tell her about infant formula, giving her the facts about which product provides which nutrition to her child. Having not been properly advised, and only aware of the fact that ‘babies drink milk’, the teenage girl goes off and feeds her baby cow’s milk.

“Further, the options available to adoptive or foster parents or the commissioning parents in a surrogate motherhood agreement (or in any other instances where there is no lactating mother available to feed the baby) are severely restricted by these regulations.

“They will be unable to ask the health-care professional to help them make the best nutritional choice for their baby. They will also not be able to go to their local supermarket and receive information regarding ‘infant or follow-up formula for special dietary or medical purposes’ (regulation 7(1)) and make an informed decision.”

Moeng is adamant that health education will take care of this challenge.

She added: “South Africa is embarking on a comprehensive strategy to address infant feeding, with thousands of health workers currently being trained to support the initiative. In addition, the country is investing in various education initiatives.”


Walker says the likely long-term repercussions are troubling. “In Malawi, more than 10 000 front-line health workers were deployed to educate mothers on hygiene, nutrition and breast-feeding,” she says.

“The results were phenomenal, and Malawi has the highest breast-feeding rate in the world, combined with a 59 percent reduction in its under-five child mortality rate since 1990.”

However, despite a significant increase in its breast-feeding rates, Malawi has one of the highest percentages of stunted children – an indicator of malnutrition – at 48 percent, due to a lack of education about the transition from breast milk to complementary foods. The same trend is witnessed in other developing countries such as Madagascar and Peru.

“The high rate of stunted children in these countries indicates that stringent regulation is not in itself the solution; any regulation needs to provide support and education to mothers to prevent malnutrition,” says Walker. - The Mercury